ADDITIONAL ITEMS                                                   
                Additional Item Description/Incurred Date/Product/Sub Group-8 Digit/Payroll Location                 

INVOICE NUMBER:     230131587845                                           PAGE:               1 of 5            
BILL ACCOUNT NUMBER:2401631001                                             PAID CLAIMS MONTH:  January 2023      
BILL ACCOUNT NAME:  Utz Quality Foods                                      CLAIMS PAID THRU:   01/27/2023        
CLIENT NUMBER:      240163                                                 BILL CYCLE:         4 of 4            
CLIENT NAME:        Utz Quality Foods                                      PREPARED DATE:      01/31/2023        

                                        Adjustment Description                                            Adjustment Amount                              
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Graduated Medical Expense - State of New York
  12/22
    HDHP PPO
      025620-00
        ACCTS                                                                                                          $44.37
          ADM                                                                                                          $49.59
         BUFF                                                                                                           $3.59
        HCSLS                                                                                                           $5.36
      025620-00 Total                                                                                                 $102.91
    HDHP PPO Total                                                                                                    $102.91
    PPO
      025620-01
          ADM                                                                                                         $130.01
          NEW                                                                                                          $16.81
         ROCH                                                                                                          $19.70
      025620-01 Total                                                                                                 $166.52
      025620-02
         BUFF                                                                                                           $3.59
         ROCH                                                                                                           $9.85
         SYRA                                                                                                           $6.20
      025620-02 Total                                                                                                  $19.64
      025620-71
          ADM                                                                                                          $15.02
      025620-71 Total                                                                                                  $15.02
    PPO Total                                                                                                         $201.18
  12/22 Total                                                                                                         $304.09
Graduated Medical Expense - State of New York Total                                                                   $304.09

                                                                                                                                                PAGE:2 of 5
                                                                                                                                                            
                                        Adjustment Description                                            Adjustment Amount                              
_____________________________________________________________________________________________________________________________________________________________

Maine Guaranteed Access Reinsurance Assessement
  10/22
    HDHP PPO
      025620-00
         AUBU                                                                                                          $24.00
      025620-00 Total                                                                                                  $24.00
    HDHP PPO Total                                                                                                     $24.00
    PPO
      025620-01
         AUBU                                                                                                          $48.00
      025620-01 Total                                                                                                  $48.00
      025620-02
         AUBU                                                                                                          $84.00
      025620-02 Total                                                                                                  $84.00
    PPO Total                                                                                                         $132.00
  10/22 Total                                                                                                         $156.00
Maine Guaranteed Access Reinsurance Assessement Tota                                                                  $156.00
                                                                                                                                                            
New Hampshire State Tax
  10/22
    PPO
      025620-01
         WILM                                                                                                          $20.55
      025620-01 Total                                                                                                  $20.55
    PPO Total                                                                                                          $20.55
  10/22 Total                                                                                                          $20.55
New Hampshire State Tax Total                                                                                          $20.55
                                                                                                                                                            
Other Claims Related Expense
  07/20
    PPO

                                                                                                                                                PAGE:3 of 5
                                                                                                                                                            
                                        Adjustment Description                                            Adjustment Amount                              
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      025620-02
         PITT                                                                                                          $35.00
      025620-02 Total                                                                                                  $35.00
    PPO Total                                                                                                          $35.00
  07/20 Total                                                                                                          $35.00
  08/20
    PPO
      025620-02
         PITT                                                                                                          $35.00
      025620-02 Total                                                                                                  $35.00
    PPO Total                                                                                                          $35.00
  08/20 Total                                                                                                          $35.00
  09/20
    PPO
      025620-02
         PITT                                                                                                          $35.00
      025620-02 Total                                                                                                  $35.00
    PPO Total                                                                                                          $35.00
  09/20 Total                                                                                                          $35.00
  10/20
    PPO
      025620-02
         PITT                                                                                                          $17.97
      025620-02 Total                                                                                                  $17.97
    PPO Total                                                                                                          $17.97
  10/20 Total                                                                                                          $17.97
Other Claims Related Expense Total                                                                                    $122.97
                                                                                                                                                            
Rhode Island State Tax
  10/22
    PPO
      025620-01

                                                                                                                                                PAGE:4 of 5
                                                                                                                                                            
                                        Adjustment Description                                            Adjustment Amount                              
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
         NEAS                                                                                                          $14.24
      025620-01 Total                                                                                                  $14.24
      025620-02
         PROV                                                                                                          $10.68
      025620-02 Total                                                                                                  $10.68
    PPO Total                                                                                                          $24.92
  10/22 Total                                                                                                          $24.92
Rhode Island State Tax Total                                                                                           $24.92
                                                                                                                                                            
Vermont IT Fund
  10/22
    PPO
      025620-01
        WRIVR                                                                                                          $10.08
      025620-01 Total                                                                                                  $10.08
    PPO Total                                                                                                          $10.08
  10/22 Total                                                                                                          $10.08
Vermont IT Fund Total                                                                                                  $10.08
                                                                                                                                                            
Washington State Tax 
  10/22
    HDHP PPO
      025620-00
        TMPLT                                                                                                           $6.00
      025620-00 Total                                                                                                   $6.00
    HDHP PPO Total                                                                                                      $6.00
    PPO
      025620-01
        TMPLT                                                                                                           $9.06
      025620-01 Total                                                                                                   $9.06
      025620-02
        TMPLT                                                                                                           $5.46

                                                                                                                                                PAGE:5 of 5
                                                                                                                                                            
                                        Adjustment Description                                            Adjustment Amount                              
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
      025620-02 Total                                                                                                   $5.46
      025620-72
        COBRA                                                                                                           $0.18
      025620-72 Total                                                                                                   $0.18
    PPO Total                                                                                                          $14.70
  10/22 Total                                                                                                          $20.70
Washington State Tax  Total                                                                                            $20.70
                                                                                                                                                            
Additional Items Total                                                                                                $659.31